Team-based approach to identify cardiac toxicity in critically ill hematopoietic stem cell transplant recipients

Christopher E. Dandoy, Sonata Jodele, Zachary Paff, Russel Hirsch, Thomas D. Ryan, John Jefferies, Michelle Cash, Seth Rotz, Abigail Pate, Michael D. Taylor, Javier El-Bietar, Kasiani C. Myers, Gregory Wallace, Adam Nelson, Michael Grimley, Thomas Pfeiffer, Adam Lane, Stella M. Davies, Ranjit S. Chima

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction: We observed pulmonary hypertension (PH), pericardial effusions, and left ventricular systolic dysfunction (LVSD) in multiple critically ill hematopoietic stem cell transplant (HSCT) recipients. We implemented routine structured echocardiography screening for HSCT recipients admitted to the pediatric intensive care unit (PICU) using a standardized multidisciplinary process. Methods: HSCT recipients admitted to the PICU with respiratory distress, hypoxia, shock, and complications related to transplant-associated thrombotic microangiopathy were screened on admission and every 1–2 weeks thereafter. Echocardiography findings requiring intervention and/or further screening included elevated right ventricular pressure, LVSD, and moderate to large pericardial effusions. All echocardiograms were compared to the patient's routine pretransplant echocardiogram. Results: Seventy HSCT recipients required echocardiography screening over a 3-year period. Echo abnormalities requiring intervention and/or further screening were found in 35 (50%) patients. Twenty-four (34%) patients were noted to have elevated right ventricular pressure; 14 (20%) were at risk for PH, while 10 (14%) had PH. All patients with PH were treated with pulmonary vasodilators. LVSD was noted in 22 (31%) patients; 15/22 (68%) received inotropic support. Moderate to large pericardial effusions were present in nine (13%) patients, with six needing pericardial drain placement. Discussion: Echocardiographic abnormalities are common in critically ill HSCT recipients. Utilization of echocardiogram screening may allow for early detection and timely intervention for cardiac complications in this high-risk cohort.

Original languageEnglish (US)
Article numbere26513
JournalPediatric Blood and Cancer
Volume64
Issue number10
DOIs
StatePublished - Oct 1 2017
Externally publishedYes

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Hematopoietic Stem Cells
Critical Illness
Transplants
Pulmonary Hypertension
Pericardial Effusion
Left Ventricular Dysfunction
Echocardiography
Pediatric Intensive Care Units
Ventricular Pressure
Thrombotic Microangiopathies
Vasodilator Agents
Cardiotoxicity
Transplant Recipients
Shock
Lung

All Science Journal Classification (ASJC) codes

  • Pediatrics, Perinatology, and Child Health
  • Hematology
  • Oncology

Cite this

Team-based approach to identify cardiac toxicity in critically ill hematopoietic stem cell transplant recipients. / Dandoy, Christopher E.; Jodele, Sonata; Paff, Zachary; Hirsch, Russel; Ryan, Thomas D.; Jefferies, John; Cash, Michelle; Rotz, Seth; Pate, Abigail; Taylor, Michael D.; El-Bietar, Javier; Myers, Kasiani C.; Wallace, Gregory; Nelson, Adam; Grimley, Michael; Pfeiffer, Thomas; Lane, Adam; Davies, Stella M.; Chima, Ranjit S.

In: Pediatric Blood and Cancer, Vol. 64, No. 10, e26513, 01.10.2017.

Research output: Contribution to journalArticle

Dandoy, CE, Jodele, S, Paff, Z, Hirsch, R, Ryan, TD, Jefferies, J, Cash, M, Rotz, S, Pate, A, Taylor, MD, El-Bietar, J, Myers, KC, Wallace, G, Nelson, A, Grimley, M, Pfeiffer, T, Lane, A, Davies, SM & Chima, RS 2017, 'Team-based approach to identify cardiac toxicity in critically ill hematopoietic stem cell transplant recipients', Pediatric Blood and Cancer, vol. 64, no. 10, e26513. https://doi.org/10.1002/pbc.26513
Dandoy, Christopher E. ; Jodele, Sonata ; Paff, Zachary ; Hirsch, Russel ; Ryan, Thomas D. ; Jefferies, John ; Cash, Michelle ; Rotz, Seth ; Pate, Abigail ; Taylor, Michael D. ; El-Bietar, Javier ; Myers, Kasiani C. ; Wallace, Gregory ; Nelson, Adam ; Grimley, Michael ; Pfeiffer, Thomas ; Lane, Adam ; Davies, Stella M. ; Chima, Ranjit S. / Team-based approach to identify cardiac toxicity in critically ill hematopoietic stem cell transplant recipients. In: Pediatric Blood and Cancer. 2017 ; Vol. 64, No. 10.
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title = "Team-based approach to identify cardiac toxicity in critically ill hematopoietic stem cell transplant recipients",
abstract = "Introduction: We observed pulmonary hypertension (PH), pericardial effusions, and left ventricular systolic dysfunction (LVSD) in multiple critically ill hematopoietic stem cell transplant (HSCT) recipients. We implemented routine structured echocardiography screening for HSCT recipients admitted to the pediatric intensive care unit (PICU) using a standardized multidisciplinary process. Methods: HSCT recipients admitted to the PICU with respiratory distress, hypoxia, shock, and complications related to transplant-associated thrombotic microangiopathy were screened on admission and every 1–2 weeks thereafter. Echocardiography findings requiring intervention and/or further screening included elevated right ventricular pressure, LVSD, and moderate to large pericardial effusions. All echocardiograms were compared to the patient's routine pretransplant echocardiogram. Results: Seventy HSCT recipients required echocardiography screening over a 3-year period. Echo abnormalities requiring intervention and/or further screening were found in 35 (50{\%}) patients. Twenty-four (34{\%}) patients were noted to have elevated right ventricular pressure; 14 (20{\%}) were at risk for PH, while 10 (14{\%}) had PH. All patients with PH were treated with pulmonary vasodilators. LVSD was noted in 22 (31{\%}) patients; 15/22 (68{\%}) received inotropic support. Moderate to large pericardial effusions were present in nine (13{\%}) patients, with six needing pericardial drain placement. Discussion: Echocardiographic abnormalities are common in critically ill HSCT recipients. Utilization of echocardiogram screening may allow for early detection and timely intervention for cardiac complications in this high-risk cohort.",
author = "Dandoy, {Christopher E.} and Sonata Jodele and Zachary Paff and Russel Hirsch and Ryan, {Thomas D.} and John Jefferies and Michelle Cash and Seth Rotz and Abigail Pate and Taylor, {Michael D.} and Javier El-Bietar and Myers, {Kasiani C.} and Gregory Wallace and Adam Nelson and Michael Grimley and Thomas Pfeiffer and Adam Lane and Davies, {Stella M.} and Chima, {Ranjit S.}",
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T1 - Team-based approach to identify cardiac toxicity in critically ill hematopoietic stem cell transplant recipients

AU - Dandoy, Christopher E.

AU - Jodele, Sonata

AU - Paff, Zachary

AU - Hirsch, Russel

AU - Ryan, Thomas D.

AU - Jefferies, John

AU - Cash, Michelle

AU - Rotz, Seth

AU - Pate, Abigail

AU - Taylor, Michael D.

AU - El-Bietar, Javier

AU - Myers, Kasiani C.

AU - Wallace, Gregory

AU - Nelson, Adam

AU - Grimley, Michael

AU - Pfeiffer, Thomas

AU - Lane, Adam

AU - Davies, Stella M.

AU - Chima, Ranjit S.

PY - 2017/10/1

Y1 - 2017/10/1

N2 - Introduction: We observed pulmonary hypertension (PH), pericardial effusions, and left ventricular systolic dysfunction (LVSD) in multiple critically ill hematopoietic stem cell transplant (HSCT) recipients. We implemented routine structured echocardiography screening for HSCT recipients admitted to the pediatric intensive care unit (PICU) using a standardized multidisciplinary process. Methods: HSCT recipients admitted to the PICU with respiratory distress, hypoxia, shock, and complications related to transplant-associated thrombotic microangiopathy were screened on admission and every 1–2 weeks thereafter. Echocardiography findings requiring intervention and/or further screening included elevated right ventricular pressure, LVSD, and moderate to large pericardial effusions. All echocardiograms were compared to the patient's routine pretransplant echocardiogram. Results: Seventy HSCT recipients required echocardiography screening over a 3-year period. Echo abnormalities requiring intervention and/or further screening were found in 35 (50%) patients. Twenty-four (34%) patients were noted to have elevated right ventricular pressure; 14 (20%) were at risk for PH, while 10 (14%) had PH. All patients with PH were treated with pulmonary vasodilators. LVSD was noted in 22 (31%) patients; 15/22 (68%) received inotropic support. Moderate to large pericardial effusions were present in nine (13%) patients, with six needing pericardial drain placement. Discussion: Echocardiographic abnormalities are common in critically ill HSCT recipients. Utilization of echocardiogram screening may allow for early detection and timely intervention for cardiac complications in this high-risk cohort.

AB - Introduction: We observed pulmonary hypertension (PH), pericardial effusions, and left ventricular systolic dysfunction (LVSD) in multiple critically ill hematopoietic stem cell transplant (HSCT) recipients. We implemented routine structured echocardiography screening for HSCT recipients admitted to the pediatric intensive care unit (PICU) using a standardized multidisciplinary process. Methods: HSCT recipients admitted to the PICU with respiratory distress, hypoxia, shock, and complications related to transplant-associated thrombotic microangiopathy were screened on admission and every 1–2 weeks thereafter. Echocardiography findings requiring intervention and/or further screening included elevated right ventricular pressure, LVSD, and moderate to large pericardial effusions. All echocardiograms were compared to the patient's routine pretransplant echocardiogram. Results: Seventy HSCT recipients required echocardiography screening over a 3-year period. Echo abnormalities requiring intervention and/or further screening were found in 35 (50%) patients. Twenty-four (34%) patients were noted to have elevated right ventricular pressure; 14 (20%) were at risk for PH, while 10 (14%) had PH. All patients with PH were treated with pulmonary vasodilators. LVSD was noted in 22 (31%) patients; 15/22 (68%) received inotropic support. Moderate to large pericardial effusions were present in nine (13%) patients, with six needing pericardial drain placement. Discussion: Echocardiographic abnormalities are common in critically ill HSCT recipients. Utilization of echocardiogram screening may allow for early detection and timely intervention for cardiac complications in this high-risk cohort.

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